ATI RN
The Hematologic System ATI Questions
Question 1 of 5
A 5-year-old boy is evaluated for apparent ongoing hemolysis. His hemoglobin is 9.5 g/dL, with 8% reticulocytes and MCV 87 fL. Platelets and leukocytes are normal. His direct antiglobulin test (DAT) is negative. No cold agglutinin is detectable. His family history is negative for blood disorders. Peripheral smear reveals basophilic stippling in 10% of the red blood cells. Given these findings, which of the following blood disorders is most likely?
Correct Answer: E
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
Question 2 of 5
A 4-year-old child with acute lymphoblastic leukemia is receiving high-dose methotrexate during interim maintenance. He receives ondansetron and арrepitant during his stay, which control his nausea and vomiting well. These medications work by inhibiting signaling in which part of the brain?
Correct Answer: E
Rationale: The correct answer is D: Vomiting center. Ondansetron and aprepitant are antiemetic medications that work by inhibiting signaling in the vomiting center of the brain. The vomiting center is located in the medulla oblongata in the brainstem, which plays a crucial role in triggering the reflexes that lead to nausea and vomiting. By blocking signals in the vomiting center, these medications effectively prevent and control nausea and vomiting. Incorrect choices: A: The vestibular system is responsible for balance and spatial orientation, not for controlling nausea and vomiting. B: The cerebral cortex is involved in higher brain functions such as thinking and decision-making, not in regulating nausea and vomiting. C: The hypothalamus regulates various physiological processes like temperature regulation and hormone release, but it is not directly involved in controlling nausea and vomiting.
Question 3 of 5
A 4-year-old boy is pale with intermittent jaundice and splenomegaly. Laboratory results are as follows: RBC 4.85 M/mcL (N); Hgb 8.6 g/dL (L); Hct 25.8% (L); MCV 81.6 (N); MCHC 38% (H); RDW 20% (H); Retic 7% (H). What are the two best tests to distinguish autoimmune hemolytic anemia from hereditary spherocytosis?
Correct Answer: E
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
Question 4 of 5
An 18-year old male patient with acute lymphoblastic leukemia recently started maintenance therapy and is complaining of increased hip pain. The pain increases during weight-bearing activity; however, it occasionally hurts at night as well. His CBCd is normal. Which of the following risk factors is most commonly associated with this process?
Correct Answer: D
Rationale: The correct answer is D: Dexamethasone exposure. Dexamethasone is a corticosteroid commonly used in the treatment of acute lymphoblastic leukemia. It can cause avascular necrosis of the hip due to its effect on bone metabolism, leading to increased hip pain during weight-bearing activities. This is a known side effect seen more commonly in patients exposed to dexamethasone. Incorrect Choices: A: Younger age at diagnosis - Age is not a known risk factor for avascular necrosis in this context. B: Non-White race - Race is not a known risk factor for avascular necrosis in this context. C: Low body-mass index - Body mass index is not a known risk factor for avascular necrosis in this context.
Question 5 of 5
An 18-year old male patient presents with bruising, fatigue, and diffuse extremity pain. He is noted to be tachypneic and hypoxic and has a diffuse interstitial infiltrate on chest x-ray. CBC reveals a WBC count of 285,000/mm3 (85% myeloblasts, with monocytic morphology), hemoglobin of 7.9 g/dL, and platelet count of 36,000/mm3. What is the most likely cause of the infiltrate and respiratory symptoms and the most appropriate initial treatment?
Correct Answer: B
Rationale: The correct answer is B: Hyperleukocytosis; leukapheresis or manual exchange transfusion and initiation of induction chemotherapy. In this scenario, the patient's symptoms and lab findings are consistent with acute myeloid leukemia (AML) with leukostasis, causing hypoxia and interstitial infiltrates. Leukapheresis or manual exchange transfusion is crucial to rapidly reduce the high white blood cell count, which can help alleviate symptoms and prevent complications like tissue hypoxia. Initiation of induction chemotherapy is also essential for long-term management of AML. Rationale for why other choices are incorrect: A: Hyperleukocytosis alone without leukostasis does not typically require immediate leukoreduction, as in this case. Induction chemotherapy should be initiated promptly to address the underlying AML. C: COVID-19 infection would not typically present with such profound leukocytosis and monocytic morphology. Convalescent plasma and prednisone are not